Brief Answer: need clarifications Detailed Answer: Dear XXXXXXX Thanks for contacting Ayurveda with your health concern and following points need clarifications for better understanding and management of the subject. 1. problem of discharge of fluid when bending ahead: was CSF rhinorrhea established as the diagnosis? 2. it could be CSF leak: was this made after clinical examination [neurosurgeon/ENT surgeon] and Laboratory Investigations [CT/MRI-head] or on theoretical grounds?? [is/was source of CSF leak identified]?? 3. any associated symptoms like headaches, blurry vision,dizziness,nausea, tiredness and metallic taste in the mouth. Tinnitus, tingling in arms and legs and weakness of facial muscles are other signs...please specify [if any]? 4. CSF leak is more common in overweight patients or those who have suffered head trauma from an accident. [any history of the same]? PS. The condition can be fatal due to the high risk of infections like meningitis rather than from the loss of brain fluid which the body constantly produces. please revert back with above said concerns for Ayurveda approach Dr. Munish Sood Consultant & Physician Naimittika

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Brief Answer: Treatment & Management Detailed Answer: Dear XXXXXXX Thanks for reverting back with your clarifications and concern raised. 1.Beta-2 transferrin, the desialylated form of transferrin, is located only in cerebrospinal fluid, the aqueous and vitreous humors of the eye, and fluid within the cochlea, test of a nasal fluid sample for beta-2 transferrin is the most direct method of determining whether the fluid is CSF or not. [if still in doubt] 2. Head end elevation to reduce pooling in throat, diuretics [मूत्रविरेचनीय] to reduce ICP [intra cranial pressure] and laxatives to regulate bowel movement. 3.Combined HRCT and MRI in the detection of CSF Rhinorrhea is the preferred treatment followed by many Doctors [you may ask about the same] 4.Since presently site of CSF leak is not determined, which probably means that cause is still uncertain, follow your attending Physician advise and take Ayurveda Drugs after consulting an Ayurveda Physician near you. Dr. Munish Sood Naimittika

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Brief Answer: Surgical Exploration Detailed Answer: Hi, Below are the clarifications of your concern raised. 1.High-resolution CT cisternography provides good bony details, but fluid is poorly detected whereas T2-weighted magnetic resonance imaging (MRI) shows CSF as a bright signal, but spatial resolution is poor as is the depiction of bony details, so to overcome the shortcomings of both techniques, now a day’s Doctors superimpose the images obtained from each modality and uses the result to plan surgical explorations. PS. Superimposing the images of CTs and MRIs one can accurately localize the site of CSF leakage with a sensitivity of 89.74% and this is called as “combined HRCT and MRI” procedure which means that instead of going for only one procedure you can ask your Doctor to perform these two procedures simultaneously. 2.Since cause of leak is not certain and moreover it’s a surgical issue, so medical aspect [conservative management] is explained for prophylaxis and as said earlier, meningitis is the most severe and feared complication of CSF leak and is associated with high mortality rate, so prompt surgical closure is advocated. PS. Headache and blurry vision signifies high ICP [intra cranial pressure] which means there is pressure on the brain stem, so in order to restore the circulation, surgery is best management. 3.Knowing our limitations, it is best in the interest of you and the patient to go for surgical management of the disease, while Ayurveda drugs can be given till conservative management and after post surgery. PS. don't fall for marketing gimmicks Dr. Munish Sood Naimittika

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